Psychiatric Boarding: Understanding Incentives between Payers, Providers, and Patients
The mental health system in the United States has historically lacked appropriate care for patients experiencing severe mental illness. During the 1960s, mental healthcare shifted from institutional settings to community-based services [1]. Although this shift gave patients with severe mental illness more autonomy over their care, it led to market forces driving a reduction in psychiatric beds without a parallel increase in support for community services [2]. As such, patients seeking preventative care for severe mental illness face long waitlists for community-based services; instead, these patients divert to ill-equipped emergency departments (EDs) for treatment of acute episodes but likewise wait long periods in hallways or other emergency room areas for an inpatient bed, also known as “boarding.”
